Venous and arterial air embolism: a rare phenomenon with fatal consequences

• Published in: BMJ case reports Vol. 2016; p. bcr2016217550
• Main Authors: Shah, Jatan, Jiwa, Nasheena, Mamdani, Natasha, Hill, David
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 05-12-2016; BMJ Publishing Group
• Series: Case Report
• Subjects: 80 years; Aged; Aged, 80 and over; Black; Bubbles; Cardiovascular disease; Catheterization, Central Venous - adverse effects; Catheters; Coma; Contrast Media - administration & dosage; Contrast Media - adverse effects; Coronary Artery Bypass - adverse effects; Coronary vessels; Dyspnea; Edema; Electrocardiography; Embolism, Air - complications; Embolism, Air - diagnosis; Embolism, Air - physiopathology; Embolisms; Family medical history; Female; Glucocorticoids - therapeutic use; Heart attacks; Humans; Infusions, Intravenous - adverse effects; Learning from Errors; Male; Medical imaging; Mortality; Oxygen therapy; Pulmonary arteries; Treatment Outcome; USA/Canada; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-217550

Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air embolism occurred in venous and arterial circulation after contrast medium injection (CMI) and coronary artery bypass graft (CABG) surgery, respectively. In one case, accumulation of air bubbles was observed in the pulmonary artery after CMI. This was attributed to inadvertent injection of air owing to improper connection of the injector and the catheter. The patient was managed with 100% oxygen in the Trendelenburg and left lateral decubitus position. Repeat imaging demonstrated resorption of the emboli. In another case, air was introduced during CABG in the left atrium and ventricle. Immediate suction of air was attempted however, the patient developed cardiogenic shock requiring vasopressors, and subsequently seizures and coma due to diffuse ischaemic stroke. The patient eventually expired.